Table 4.

Specific Metals Associated with Different Presentations of Respiratory Hypersensitivity.

	Hypersensitivity Mechanism
	Type I				Type IV
Metal	IgE-Mediated Asthma	IgG-Mediated Asthma	Allergic Rhinitis	Immediate Hypersensitivity Laryngitis	T-Cell-Mediated Asthma	Hypersensitivity Pneumonitis
Aluminum	(Park, Uh, and Park 1996;  Vandenplas et al. 1998)		(Lastovkova et al. 2015)
Beryllium						(Haley 1991; Rossman et al. 1988)
Chromium	(Wittczak et al. 2012; De Raeve et al. 1998)		(Fregert 1982; Hassmanová, Vanĕcková, and Bousová 2000)		(Olaguibel and Basomba 1989)
Cobalt	(Wittczak et al. 2012)	(Cirla 1994)	(Walters et al. 2012)		(Kusaka et al. 1989; De Hauteclocque et al. 2002)	(Baik, Yoon, and Park 1995; Van Cutsem et al. 1987)
Gold				(Kilpikari 1997)		(Tomioka and King 1997; Agarwal, Sharma, and Malaviya 1989)
Iron	(Munoz et al. 2009)					(Yamamoto et al. 2020)
Manganese	(Wittczak et al. 2012)		(Hedmer et al. 2014)
Mercury	(Drouet et al. 1990; Kal et al. 2008)
Nickel	(Wittczak et al. 2012; Spinelli et al. 2005)		(Estlander et al. 1993; Niordson 1981)	(Buyukozturk et al. 2013)	(Kusaka et al. 1991; De Hauteclocque et al. 2002; Malo et al. 1985)	(Franzen et al. 2017)
Palladium			(Pesonen et al. 2014)
Platinum	(Merget et al. 1994; Marshall 1952)	(Pepys et al. 1979)	(Malo 2005)		(Kazantzis 1978)
Rhodium	(Merget et al. 2010)		(Merget et al. 2010)
Tungsten	(Bruckner 1967; Miyamoto, Inoue, and Watanabe 2005)
Vanadium	(Musk and Tees 1982; Irsigler, Visser, and Spangenberg 1999)
Zinc	(Malo and Cartier 1987; Malo, Cartier, and Dolovich 1993)					(Ameille et al. 1992; Costabel et al. 2020)
Zirconium						(Liippo et al. 1993)
Stainless Steel*	(Keskinen, Kalliomaki, and Alanko 1980)		(Castano and Suarthana 2014)	(Hannu, Piipari, and Toskala 2006)

Table 4: Metals implicated in different forms of respiratory allergy. Common presentations of metal allergy that selectively manifest in the respiratory tract are listed in the table above. Responses are grouped by primary mechanism of hypersensitivity and specific metals implicated in each disease variant are denoted by the parenthesized numbers within the assoicated column, which correspond to relevant citations.

^*Stainless steel is an alloy comprised of many metals (e.g., iron, nickel, chromium, titanium, etc.), and while the compound has been implicated in some cases of allergy, it is unclear which of the constituent metal(s) is responsible for the observed effects in many cases.